RESUMO
Background: Thyroid incidentalomas detected by 18F-Fludeoxyglucose (FDG) PET/CT are defined as an incidental and unexpected thyroid focus present in a patient studied for a non-thyroid disease. Aim: To assess the frequency of malignancy of nodular thyroid incidentalomas, and their association with 18F-FDG avidity (standard uptake value (SUV) max). Material and Methods: Whole body PET/CT performed from December 2008 to December 2017 were reviewed selecting those that showed nodular thyroid foci. Glands with diffuse increased uptake were excluded. Thyroid ultrasonography and fine-needle aspiration cytology (FNAC) performed after PET/CT were reviewed. Bethesda score and SUVmax were correlated. Results: Of 5,100 whole body 18F-FDG PET/CT, 119 showed a thyroid nodular uptake (2.3%). Forty eight percent of these patients were studied with FNAC or surgery, 50% of which (29/58) were confirmed as malignant. Benign nodules showed significantly lower 18F-FDG uptake (n = 20, SUVmax: 3.5 ± 1.7) than Bethesda V-VI (n=24, SUVmax: 8.2 ± 5.2) and thyroid metastases (n=5, SUVmax: 6.3 ± 2.1). The best cut-off value to distinguish between benign and malignant nodules was a SUVmax of 5.0, with a sensitivity of 76% (95% confidence intervals (CI) 56-90%), a specificity of 85% (95% CI 62 - 97%), and positive likelihood ratio of 5 (95% CI 1.8 - 14.6). The size of the thyroid nodule was not predictive of malignancy. Conclusions: Half of nodular thyroid incidentalomas detected by 18F-FDG PETC/CT are malignant. A nodule with a SUVmax ≥ 5,0 is highly suggestive of malignancy, regardless of its size.
Assuntos
Humanos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Nódulo da Glândula Tireoide , Estudos Retrospectivos , Compostos Radiofarmacêuticos , Fluordesoxiglucose F18 , Achados Incidentais , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaRESUMO
La vitamina D es un tema de moda, proviene en un 80% su obstención de la luz so-lar. Los niveles de suficiencia de vitamina D varían según la sociedad encuestada, en Chile no los conocemos. Se ha asociado el deficit de vitamina D a múltiples pa-tologías, su rol en la patología ósea esta claro. Es su rol extraóseo el que cada día toma un rol importante, la literatura habla de asociaciones no de causalidad ni de prevención al tener niveles de vitamina D adecuados. Hay riesgo de intoxicación con niveles mayores a 80ng/ml de vitamina D, por lo que, no se debe sobretratar y evitar dosis de cargas con niveles de deficit y no de insuficiencia.
Vitamin D is a hot topic, probably 80% of its is received with sunlight. Vitamin D sufficiency levels change according to the society surveyed, we don't know them in Chile. Vitamin D deficiency has been associated with multiple pathologies, its role in bone pathology is clear. It is its extraoseo role that every day takes an im-portant role, although the literature speaks of associations not of causation or prevention by having reduced vitamin D levels. There is a risk of intoxication with levels greater than 80 ng/mlof vitamin D, therefore, do not over-treat and avoid doses of loads with deficit levels and not insufficiency.